Suzanne Somers and the Future of Breast Reconstruction

Suzanne Somers is famous for her alternative approach to health. So when she lost most of one breast to cancer 10 years ago, she wasn't about to settle for just any old implant. Here, the story of how she waited for — and got — the breast she'd always wanted.

Don't Miss This

FRIDAY, Dec. 16, 2011 - Suzanne Somers has never cared much for convention. Given a choice between business as usual and the road not taken, she’ll almost always choose the latter - especially where her health is concerned. In 2006, she sparked a much-publicized debate when she spoke out in favor of bioidentical hormone therapy, a controversial treatment for menopause that was the subject of her book Ageless: The Naked Truth About Bioidentical Hormones. Then, in 2008, she made headlines again when she published another book, Knockout, advocating alternative cancer treatments over traditional methods like chemotherapy and radiation.

“I appreciate health care that gets to the root cause of our symptoms and promotes wellness, rather than the one-size-fits-all drug-based approach to treating disease,” explains Somers, 65. “I love maintaining an optimal quality of life - naturally.”

Somers first began researching alternative cancer therapies in 2001, after doctors found a tumor in one of her breasts. At the time, she declined chemotherapy but had a lumpectomy and 35 days of radiation, which left the right side of her chest deflated and small. Surgeons offered her two reconstructive options: implants (plural, meaning they would have to also remove her healthy breast) or a TRAM flap, a procedure that uses muscle, fat, and skin from the abdomen to create a new breast. Most women seeking post-treatment reconstruction choose one or the other - but Somers is not most women.

The Birth of Cell-Assisted Lipotransfer for Breast Reconstruction

A few years later, something did come along. In 2003, Kotaro Yoshimura, MD, a professor and surgeon at the University of Tokyo in Japan, began testing an innovative procedure he called cell-assisted lipotransfer, or CAL, in which autologous adipose-derived stem cells (those extracted from a person’s own fat) are injected along with other fat cells to plump up or replace tissue, as in the breast.

Transplanting fat alone is not a particularly novel undertaking - fat transplants were first performed more than a century ago and have been used by cosmetic surgeons in recent years to fill wrinkles, lift buttocks, and enlarge breasts, among other things - but fat transplantation does have a somewhat controversial history. The American Society of Plastic Surgeons deemed it safe only within the last couple of years, and some questions still remain about its long-term risks and viability. Plus, because it takes several days for blood vessels to reach the transplanted fat, some of the cells (as much as 60 percent) die or atrophy after injection, often resulting in the need for follow-up procedures. And while there’s little chance of rejection with fat grafts - because they’re your body’s own tissue - there is a risk of calcification (hardening), which some experts worry could interfere with future breast cancer diagnoses.

To help remedy some of these issues, Dr. Yoshimura came up with the idea to enrich the injected fat with a higher concentration of stem cells. Stem cells are thought to help preserve and even regenerate fat cells by stimulating growth of blood vessels.

Adipose tissue, or body fat, already contains a certain number of stem cells - about one for every four adipocyte fat cells - but Yoshimura and his colleagues believed that increasing the concentration could enhance survival rates of the tissue and reduce post-operative atrophy. To do this, they used liposuction to remove fat from another part of the patient’s body (for example, her stomach, hip, or thigh), set aside a portion of it to be reinjected, and then isolated the stem cells from the remaining tissue to be combined with the reserved fat. This stem cell-rich mixture was then used as a kind of natural cosmetic filler.

Initial results were promising, and other trials soon followed. To date, Yoshimura has performed the procedure on more than 400 women.

How Suzanne Somers Got Her Breast Back

Somers first heard about Yoshimura and his work with stem cells while writing her book Breakthrough: Eight Steps to Wellness. As part of her research, she interviewed a variety of doctors and specialists, including one who told her about the cell-assisted lipotransfer trials happening in Japan, which by that point had been going on for a few years. The possibility of natural reconstruction intrigued her, so she set out to learn more about how the procedure was done and whether she might make a good candidate, even meeting twice with Yoshimura in Los Angeles and traveling to Korea to consult with Kwang Yul Cha, MD, a leading stem cell researcher and owner of Hollywood Presbyterian Hospital in Los Angeles.

After researching cell-assisted lipotransfer, meeting with the appropriate doctors, and talking it over with her family, Somers decided in 2008 to move forward with the surgery. Shortly after, through Yoshimura and Cha, she met Joel Aronowitz, MD, a plastic surgeon at the Cedars-Sinai Plastic and Reconstructive Surgery Center in Los Angeles and founder of the Breast Preservation Foundation, a non-profit organization dedicated to educating women about their surgical options before and after breast cancer treatment. Dr. Aronowitz had gone to Tokyo to observe Yoshimura in action and was hard at work on setting up the University Stem Cell Center in Santa Monica, Calif., a joint project with his colleague James Watson, MD, to provide similar clinical trials in the United States.

Breaking New Ground in the United States With CAL

At the time, there were no such trials already under way in the United States, which meant that Somers would have to either leave the country to get the surgery or push for a new trial stateside. Wanting other women in America to have the same opportunities she had, she chose the latter - and then set about going through all the appropriate hoops and channels to get a trial going in Los Angeles.

Easier said than done. Once it was determined that Aronowitz and his team would perform the procedure at Hollywood Presbyterian, Somers, her surgeons, and the hospital had to begin the long, complicated process of applying for approval from an Institutional Review Board (IRB).

“The purpose of the IRB is to protect the individuals who choose to participate in a scientific study involving medical treatment,” Aronowitz explains. “When you want to do any experiment, but especially an experiment that involves human participants, the experiment design has to be reviewed by an outside independent body - in this case, made up of lay people, scientists who know about the subject, and doctors at the hospital or institution.”

In order to gain approval for the CAL trial, for example, Aronowitz and his team had to submit a written protocol - background about the procedure, the exact materials and methods they would be using, the consent forms they would give participants, and a listing of possible side effects and complications. The board then reviewed the protocol and responded with questions and suggestions, beginning a lengthy process to revise and perfect the design of the experiment.

“The biggest challenges occurred in the years waiting for approval to go forward,” Somers says. “But it was very important to me that this all be done legally and correctly.”

Her patience paid off. Earlier this year, after months of back and forth between the board and the researchers, the first official CAL trial in the United States was approved for launch. Somers was its inaugural enrollee - the first of a planned 100 participants.

Suzanne Somers’ Cell-Assisted Lipotransfer Success Story

Somers’ surgery took place last August, three years after she first decided to have the procedure and more than a decade since she’d lost her right breast to cancer. On the day of, she could barely contain her emotions.

“I had spent so many years working and wishing and waiting for this,” she recalls. “I felt like it was an important day for me, but more than that, a significant day for all American women faced with the challenge of breast cancer.”

Her family was similarly overwhelmed. “I was extremely emotional,” says Alan Hamel, Somers’ husband of more than 30 years. “I always feel uneasy anytime I hear the word ‘surgery’ or anytime anyone goes into the hospital, but I felt confident things would go okay. Still, I had moments when I got very teary, and I couldn’t put my finger on why at the time. Now that I am a few months away from it, I realize the reason was that Suzanne had waited so long for this to happen - and it was finally going forward.”

Adds Somers’ daughter-in-law Caroline, who accompanied her into the operating room: “I couldn’t help but think of my own mother, who had a radical mastectomy in the 1970s. Like many women, my mother came home with a concave breast and was so humiliated, she couldn’t lift her head out of my dad’s shoulder. This procedure is so different from what women have been offered in the past - and yet it looks so simple, so advanced, you can’t believe it’s ever been done any other way.”

Watching the surgery, Caroline adds, was one of the most fascinating experiences of her life. The whole procedure took just a couple of hours from start to finish, and most of that time was spent isolating the stem cells and mixing them with Somers’ fat, which had been taken from her hip and abdomen via liposuction. The actual “reconstruction” part of the procedure was relatively quick - but dramatic. “In less than 10 minutes, I watched this sad little breast puff up like a balloon,” Caroline recalls. “I couldn’t believe my eyes. No cutting, no blood, no implant. Just two or three small entrance holes, and suddenly there were two symmetrical breasts.”

The surgery was a success. Somers had some soreness and bruising where the fat had been taken (a normal part of the recovery, Aronowitz says), but she felt great otherwise - and she looked great, too. “I couldn’t stop showing people,” she says of her new breast. “I had to stop that, but it just amazes me every time I look at it. I came out of the ether to see the most beautiful, soft, unscarred, real breast - all me. No foreign objects, no real down time. It’s like a big present, 11 years later.”

The Future of Cell-Assisted Lipotransfer

Months after the surgery, Somers is still effusive - not just about her new body but also about the procedure itself. “This is a huge step,” she says. “Imagine what this will mean to all those women who have had mastectomies and lumpectomies that involve removing all or most of the breast.”

Those women, in fact, are a big part of why Somers pursued the procedure in the first place. “Suzanne insisted on doing this in America so it could be available to American women,” Caroline says. “Rather than go the safe route with the doctor in Japan who had much more experience, she waited to do it here. And now the door is open.”

The door is, indeed, open - but will other women follow Somers through it?

Aronowitz thinks so. Per his proposal to the IRB, he plans to complete the CAL procedure on 100 patients over the next nine months or so, after which he’ll tweak his method based on the trial results and start again.

“I’m sure that this treatment will be continued in our practice,” he says. “This is really the hot topic. The push for data is beginning in the United States. I hope that our study and Suzanne’s tenacity will empower other women to insist on the best option for their situation, too.”

The Pros and Cons of Cell-Assisted Lipotransfer

Whether CAL is the best option remains to be seen. But it does have certain advantages over more traditional methods such as implants.

The most obvious benefit, of course, is that there simply is no implant - and thus none of the associated complications, such as leakage, rupture, removal, deflation, or capsular contracture, which refers to the hardening of scar tissue around the foreign body. “[Capsular contracture] is very common after reconstruction, and especially common after radiation,” Dr. Aronowitz explains. “In fact, many plastic surgeons will not even offer an implant if the breast has been treated with radiation. It’s not widely appreciated, but radiation’s effects on the tissues continue to worsen for years after the initial treatment, which means that complications of placing an implant are much higher.”

Using your body’s own fat means there’s little risk of rejection, and because of the added stem cells, there’s also less risk of hardening or atrophying after the procedure. Plus, you get to lose undesirable fat in trouble zones like your stomach or thighs and use it to replace potentially cancerous breast tissue.

There’s also a difference in appearance. Both implants and TRAM flaps leave some scarring, which isn’t an issue with CAL, since there’s no cutting involved - the fat is injected. Aronowitz notes, however, that results are best if the skin and nipple are still intact. He advises that women consult with a plastic surgeon even before they go under the knife for a lumpectomy or mastectomy.

“That’s a very important point to make,” he notes. “Women should be encouraged to seek out these alternatives before they have disfiguring breast surgery.” And that’s true regardless of what kind of reconstruction they want.

CAL isn’t necessarily a replacement for traditional options, Aronowitz explains - just an alternative to them. “I don’t think we’re going to replace breast implants anytime soon. Nor should we,” he says. “But I do think there are a lot of women who have problems with implants or who just don’t like the idea of implants. And for them, a cell-assisted lipo transplant may be ideal.”

Of course, as with any procedure, there are still some risks. The main concern with CAL is that we don’t know the long-term effects or results. The assumption - or hope - is that the stem cells turn into or regrow fatty tissue, but critics say there’s really no way to know whether they’ll turn into something else. Some worry that the injected cells could become cancerous themselves. Aronowitz says, however, that this is “not likely, since fat, unlike normal breast tissue, almost never becomes cancerous.”

Another concern is that microcalcification may occur over time, making it difficult to read mammograms. But studies of tradition fat injections - with which this is also an issue - show that the calcifications that sometimes result are easily differentiated from the small fleck calcifications that mammographers see in breast cancer cases.

Other issues may arise in the future, but for now, Aronowitz says, “I would expect that this procedure will be welcomed as a very positive development and a viable choice for women.”

The key word there is choice. Breast reconstruction is a very personal matter, and what’s right for one person may not be right for another. “I understand and respect any decision patients choose to make for themselves regarding their health,” Somers says. “We all have to make the decision that is right for us and for our bodies.”

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.